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Abstrak :
Latar belakang: Insidens metastasis otak lebih tinggi dibanding tumor primer otak dan berisiko menimbulkan kematian dengan penyebab terbanyak berasal dari kanker paru (36,5%) di RSUPN Cipto Mangunkusumo (RSCM). Keterlambatan diagnosis berisiko menyebabkan herniasi otak, sehingga terjadi kecacatan dan kematian. Dibutuhkan data mengenai durasi penegakan diagnosis di RSCM. Metode penelitian: Penelitian ini merupakan studi deskriptif analitik dengan rancangan kohort retrospktif untuk mengetahui kesesuaian antara durasi penegakan diagnosis tumor otak metastasis akibat kanker paru dengan pedoman praktik klinis (durasi ≤2 minggu). Subjek merupakan pasien rawat inap di RSCM pada Januari 2019 s/d Desember 2021. Hasil: Terdapat 12 subjek (30%) dapat ditegakkan dalam waktu ≤2 minggu dengan  median durasi 18,5 hari (IQR (12-34 hari). Selain itu didapatkan durasi 7 hari (IQR 4-11 hari) untuk sampai didapatkannya massa di paru,  durasi 8 hari (IQR 4.5-13 hari) sampai dilakukannya biopsi, dan 6 hari (IQR 3.5-7 hari) sampai keluarnya hasil patologi anatomi. Tidak terdapat hubungan yang bermakna secara statistik antara variabel yang dinilai dengan durasi penegakan diagnosis ≤2 minggu (14 hari). Kesimpulan: Hanya 30% subjek dengan durasi yang sesuai dengan panduan praktik klinis di RSCM. Dibutuhkan diseminasi hasil dan kolaborasi antar bagian agar penegakan diagnosis lebih cepat. ......Background: Incidence of brain metastases is higher than primary brain tumors, with lung cancer as common etiology (36.5%) at Cipto Mangunkusumo General Hospital (RSCM). Delay in diagnosis can cause brain herniation, resulting in disability and death. Data is needed regarding the duration of diagnosis in RSCM. Method: This is a descriptive analytic study with a retrospective cohort design to determine the conformity between the duration of diagnosis of metastatic brain tumors due to lung cancer in daily clinical practice with clinical practice guidelines (duration 2 weeks). Subjects were inpatients at RSCM from January 2019 to December 2021 Results: There were 12 subjects (30%) who could be diagnosed within 2 weeks with a median duration of 18.5 days (IQR (12-34 days). Duration of 7 days (IQR 4-11 days) to obtain a lung mass, 8 days (IQR 4.5-13 days) until a biopsy was performed, and 6 days (IQR 3.5-7 days) until anatomic pathology results were released. There is no statistically significant relationship between the variables assessed and the duration of diagnosis 2 weeks. Conclusion: Only 30% of subjects with the duration matched the clinical practice guidelines at RSCM. Dissemination of results and collaboration between departments is needed to make diagnosis faster.

Abstrak :
Tujuan: Menilai kesintasan pasien metastasis otak yang menjalani radioterapi di RSUPN Dr. Cipto Mangunkusumo dan kesesuaian terhadap stratifikasi prognostik indeks Recursive Partitioning Analysis (RPA) dan Diagnosis-Specific Graded Prognostic Assessment (DS-GPA). Metode: Dilakukan studi retrospektif pada 51 pasien metastasis otak yang menjalani radiasi whole brain di RSCM pada Januari 2017-Desember 2019. Data klinis dikumpulkan melalui rekam medis. Stratifikasi pasien dilakukan berdasarkan indeks RPA dan DS-GPA. Kesintasan keseluruhan (OS) diukur sejak pasien menyelesaikan radioterapi hingga meninggal dunia atau follow-up terakhir. Kinerja indeks RPA dan DS-GPA dibandingkan menggunakan model regresi Cox. Kesintasan dinilai dengan uji Kaplan-Meier dan analisis model Cox proportional hazard. Hasil: Median kesintasan keseluruhan subyek adalah 5,3 bulan. Indeks RPA menunjukkan stratifikasi yang signifikan pada primer kanker paru dan kelompok adenokarsinoma paru. Stratifikasi DS-GPA signifikan pada primer kanker payudara dan kanker paru. Stratifikasi RPA lebih unggul dibandingkan DS-GPA pada primer kanker paru (5,752; IK95% 1,523- 21,723; p=0,004 vs 3,231; IK95% 1,008-10,350; p=0,039). Jenis kelamin (p=0,009), KPS (p=0,030), dan jumlah lesi intrakranial (p=0,023) merupakan faktor prognostik yang mempengaruhi kesintasan hidup pasien metastasis otak. Kesimpulan: Dalam populasi studi ini, stratifikasi prognostik indeks DS-GPA sesuai untuk diterapkan pada pasien metastasis otak dengan primer kanker payudara dan kanker paru. Stratifikasi indeks RPA pada kelompok primer kanker paru lebih baik dibandingkan DS-GPA. ......Aims: This study was aimed to assess survival of patients with brain metastases after radiotherapy in RSCM and to confirm the validation of Recursive Partitioning Analysis (RPA) and Diagnosis-Specific Graded Prognostic Assessment (DS-GPA). Materials and methods: This retrospective study included 51 patients treated with whole brain radiation between 2017 and 2019. Clinical data collected from hospital medical records were reviewed. Patients were classified by RPA and DS-GPA. Overall survival (OS) was calculated from last day of radiotherapy to death or last follow-up. The performances of RPA and DS-GPA were compared using Cox regression model. Survival was determined using the Kaplan-Meier curves and Cox proportional hazards model. Results: Median OS in this population study was 5.3 months. RPA provided significant stratification in lung cancer primary group and lung adenocarcinoma subgroup. Prognostic stratification of DS-GPA was valid in breast cancer and lung cancer groups. RPA was superior to DS- GPA in patients with lung cancer primary (5.752; 95%CI 1.523-21.723; p=0.004 vs 3.231; 95%CI 1.008-10.350; p=0.039). Sex (p=0.009), KPS (p=0.03), and number of brain lesions (p=0.023) were significant independent prognostic factors for survival in brain metastatic patients. Conclusions: In this study population, prognostic stratification of DS-GPA was valid in brain metastatic patients with breast and lung cancer primaries. RPA was valid and performed better stratification than DS-GPA in patients with lung cancer primary.